660188.pdfFR_ �
BUILDING DEPARTMENT Applicant FIR
PERMIT APPLICATION- inside Heavy Lines
NAM (OR NAME OF BUSINESS)
C, A , Hl<) /v
MAILING ADDRE
/ F 6 0-� 1B
c CITY TELEPHONE NUMBER
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ADDRESS
TE XPRONE NUMBER
ADDRESS
CITY TELEPHONE NUMBER
)f Property (Show iselow or Atmen mour uowes)
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13
1(
PERMIT
NUMBER
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CET SETPACK RI
121-A 1� -14-- 1
SPECULL INSPECTOR REQUIR3
0 YES 1314��
PLAN
CHECKED Y
BUILDING
VALUATION
WORK TO BE DONE
1
BUILDING PERMIT
FEE
2
PLUMBING
3
PERMIT FEE
0
HEAT & GAS LINE
I
4
PERMIT FEE
SIGN PERMIT
NEW
I [] SIGN
N HER 0 STORJJES
A
ADD
IEMMOLISII
10 PENCE
5
—
FE, I,
DEMOLITION
PERMIT FEE
ALTER
REPAIR
Lai RESIDENTIAL
NON-RESIDENTIAL
NUMBER OF
DWELLING
UNITS
6
—
PLAN CHECK
,F
E
PROPOSED UBE
8
AMOUNT DUE
I hereby acknowledge that I have read thin application; that the In-
formation given In correct: and that I am the owner, or the duly author-
ATTENTION
ized agent of the owner. I agree to Comply with city and state lawn regu-
TIUS PERMIT
lating construction; and In doing the work authorized thereby, no person
AUTHORIZES
will be employed In violation of the Labor Code of the State of Washington
ONLY THE
relating to Workmen's Compensation Insurance.
WORK NOTED
(Except Demolitions which shall
NOTE: Permit Limit Ojw-Uar be completed In ninety days.)
SIGNAL to ER DATE SIGNED
INSPECTION
DEPARTMENT
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Chech, Fee
PR 6-1101
This Permlt covers work to be done on private property ONLY.
Any construction on the public domain (curbs. sidewalks, driveways,
marquee*, etc.) Will require separate permlaidon.
660188
0 YES
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NO 0
U BER
M 1
04
[I YES 13 NO
69
7
APPLICATION APPROVAL
This application is not a permit until
signed by the Director of Building Inspec-
tion, or his deputy; and fees are paid, and
receipt is acknowledged in space provided.
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FILE
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